Healthcare Provider Details

I. General information

NPI: 1396721866
Provider Name (Legal Business Name): MARSHA LOUISE GILMORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 CAMBRIDGE ST YOUVILLE HOSPITAL
CAMBRIDGE MA
02138-4398
US

IV. Provider business mailing address

164 DAVIS ST
QUINCY MA
02170-2430
US

V. Phone/Fax

Practice location:
  • Phone: 617-876-4344
  • Fax: 617-234-7981
Mailing address:
  • Phone: 617-786-0774
  • Fax: 617-234-7981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number235805
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: